TOPLINE

Preoperative MRI-based T staging demonstrated oncologic risk discrimination comparable to traditional digital rectal examinations (DREs) for predicting survival outcomes in men with clinically localised or locally advanced prostate cancer (PCa) who underwent radical prostatectomy, a multicentre study found.

METHODOLOGY

• Researchers conducted a retrospective, multicentre case-control study of 4425 adult men (median age at surgery, 66 years) with clinically localised or locally advanced PCa across six European countries.
• All participants underwent preoperative multiparametric MRI alongside DREs prior to undergoing radical prostatectomy between 2015 and 2021.
• Investigators substituted MRI-derived T stages for clinical T stages (cT) within four established risk classification systems (D'Amico, European Association of Urology, National Comprehensive Cancer Network, and International Staging Collaboration for Prostate Cancer) to evaluate prognostic performance.
• The primary outcome was distant metastasis-free survival (DMFS), and secondary outcomes were biochemical recurrence-free survival (BCRFS) and overall survival. The median follow-up duration was 52 months.
• Discriminative performance was assessed using the Uno concordance index (C-index) and time-dependent area under the receiver operating characteristic (AUROC) curve.

TAKEAWAY

• MRI-based staging showed a slightly higher discriminative performance than DRE-based staging for BCRFS (C-index, 0.62 vs 0.59) and DMFS (C-index, 0.67 vs 0.65), although the latter difference was not statistically significant.
• For overall survival, discrimination was modest for all models. Across all the risk classification systems, MRI-based and DRE-based versions demonstrated comparable discrimination.
• Time-dependent AUROC curve analyses revealed no significant difference between DRE-based and MRI-based methods during follow-up.
• Subgroup analyses in patients with cT1 disease and those with a prostate-specific antigen level less than 10 ng/mL showed comparable discrimination between MRI- and DRE-based staging for both BCRFS and DMFS.

IN PRACTICE

"[The study] findings are particularly relevant given mounting evidence that challenges the clinical utility of DRE in modern PCa care," the authors wrote.

"[R]eplacing DRE with MRI staging does not compromise oncologic risk discrimination, thereby supporting a transition from historical reliance to evidence-based replacement," they added.

SOURCE

The study was led by Arthur Peyrottes, MD, MSc, Université Paris Cité, Paris, France. It was published online on July 15, 2026, in JAMA Network Open.

LIMITATIONS

The study was limited by the retrospective design; varied and non-standardised MRI scanners, field strengths, and radiologic expertise across centres; and non-uniformly validated pathologic correlations of MRI findings across centres. It was further restricted by the relatively short follow-up, modest discriminative performance across all models, and reliance on preoperative risk stratification systems using a limited set of clinical and pathologic variables.

DISCLOSURES

No funding information was provided for this study. One author disclosed receiving personal fees from AstraZeneca, BMS, Bayer, J&J, and Astellas outside this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.